Perhaps the most obvious result that often follows spinal cord injury (SCI) and disease is the inability to walk. This functional deficit, for which the simple and widespread solution is the use of wheelchairs, has profound consequences to quality of life for at least two major reasons: 1) Health—seated wheelchair use is associated with a variety of health concerns such as skin integrity and overuse injuries; and 2) Access—wheelchair dependence impacts community participation and interaction with others due to the inherent inaccessible nature of the man-made and natural environments in which we live.
Since our world is designed and built primarily for upright walking and standing, the use of conventional wheelchairs is limiting, both in terms of moving from place to place (at home and in the community), and perhaps more importantly, in terms of full and meaningful interaction with the environment and other people throughout one's normal daily activities (e.g. standing face to face). Current assistive technologies (AT) for mobility are simply not transformative, that is enabling a person with a disability a level of mobility performance approaching that of their non-disabled peers.
Two evolving mobility concepts include dynamic wheeled mobility and powered walking exoskeletons.
The first concept of dynamic wheeled mobility is exemplified in the marketplace by specialized standing and/or tilt/recline wheelchairs (both manual and powered), as well as the recently developed and commercialized “Elevation” wheelchair. Lightweight rigid manual wheelchairs, as well as modern high-end power wheelchairs, are often desired by people with SCI due to their efficient propulsion dynamics and usability, and represent an efficient means of everyday mobility for full-time wheelchair users. The addition of dynamic seating features (e.g. the capability for a user to independently and quickly adjust their seat position during normal seated usage) to wheelchairs offers greater function for activities of daily living, potential health benefits, increased community participation, and improved interaction with other people.
The second concept of powered walking exoskeletons provides a highly desired walking function that wheelchairs are not able to provide. Perhaps the two most well-known exoskeleton models are the ReWalk and Ekso systems. The development of exoskeletons aims to provide walking function to people with SCI, although they are presently typically used only under strict supervision in rehabilitation centers. Currently, their therapeutic use is hoped to provide benefits such as improved bowel and bladder function and decreased spasticity. Exoskeletons are a rapidly developing technology which may lead to solutions for some of the physical access issues described above, and with the potential for beneficial impacts on general health, gait training and rehabilitation following injury. However, the cumbersome slow gait and short travel range currently limit their use as a general purpose daily mobility device. As well, there are significant usability issues with these designs that have not yet been addressed, such as transferring into and out of the device and seating support for preventing skin breakdown associated with long term use.